I had a breast lift with saline implants placed under the muscle on 2/25/11.The left side has dropped and is perfect but the right side has always been high and a little tight on the bottom.About 12 wks after the surgery my PS started pressing on the implant to break scar tissue up.The implant has dropped a lot however the breast still looks stange compared to the left.My PS says surgery won't fix this and may make it look worse.Is this something that can be fixed with a pocket revision?
Implants Look Different, Can It Be Fixed?
Doctor Answers 18
Asymmetry after breast implants,can it be fixed?
Asymmetry of breasts is quite common. You have different size breasts with different shapes to start with. Postoperatively there is a siginificant difference between the 2 breasts. This should be able to be improved with surgery. The 2 breasts will never look exactly the same but they can be made to look much more similar. You should consult with your surgeon and see what he has to say. If he is uncomfortable in proceeeding with surgery you should seek a second consult. Good luck!
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Breast Implant Asymmetry
You have capsular contracture, that is why your surgeon began pressing on it a few months ago. This technique of pressing, better known as closed capsulotomy is not recommended for many reasons, most importantly lack of efficacy. In other words, the contracture usually comes back, as it did for you.
A surgical procedure called a total open capsulectomy should be performed along with placement of a new implant to treat the problem completely and minimize recurrance. In addition, you should consider revising your mastopexy (breast lift) to a more appropriate vertical type lift; it will significantly improve your nipple position and breast mound shape. The circumareolar mastopexy you received was insufficient for your preoperative breast shape.
The fact that your doctor was performing a closed capsulotomy on you and told you there was no surgical procedure to help you makes me concerned that you are with the wrong doctor. I highly recommend you consult with a plastic surgeon certified by the American Board of Plastic Surgery who is also consedered to be a specialist in breast and revision breast surgery. This person is most likely also a member of the American Society for Aesthetic Plastic Surgery.
Best of luck!
Breast Asymmetry After Surgery
It is possible to do a pocket revision to assist in improving the symmetry of the two breasts. One has to be very careful with the pocket dissection to prevent other issues (such as double bubble) so choose your surgeon wisely. No surgeon can ever guarantee perfection or have both breasts be identical - every patient is different in their starting point and how their body heals but I think your situation can be improved with revisionary breast surgery.
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Breast augmentation revision
There is insufficient information in your post to really answer your question. Your posted photos support your concerns regarding the right side. Since you are happy with the "perfect" left side the question really is how to make the right more like the left. It is clear that can only be achieved by surgery but it is not clear what the surgery exactly should be.
Since the breasts were asymmetrical before surgery it is impossible to make them exactly symmetric after surgery. Since the implants were presumably the same the problem is either the way the right one was placed or the skin removal pattern on the right for the lift portion of the surgery. I personally do not think it is a capsule problem. Since they were initially not the same the skin removal pattern for the lift should not have been the same for the right and left side. If your surgeon did the same patterns you may need to have adjustments made to the skin envelope at the time of revision. Since the right side has been high from presumably day one and the implant is under the muscle a most likely contributing cause of the problem is inadequate release of the pectoralis muscle on the right. Therefore your thought that a pocket revision might help is a good one.
All surgeons are at risk for tunnel vision when it comes to assessing their results. Your best bet is to have your surgeon somehow realize that revision (of skin, muscle and/or capsule) is the answer. Have him/her look at these photos in private and give him/her time to mull it over in their mind. If they are reasonable they should come to the same conclusion. To help matters you can ask them to refer you to a colleague for a second opinion. Sometimes that is required to break through the tunnel vision.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Asymmetry of Implants
Based on your pictures, you likely have a component of capsular contracture which likely require surgery to improve. However, I do not think that this is the only issue with your breasts. Based on your pre-op pictures and the post op pictures, it appears that you would have been better served with implant size and base diameter (width) which would more appropriate fit your anatomy. This can likely be significantly improved with revision surgery.
Revision agfter breast augmentation
Revision is definitely indicated and you can and should expect a much better and more natural result.
Your skin envelopes are asymmetric, suggesting the need for more aggressive tailoring of the skin (read: lift; mastopexy). I would certainly recommend exchanging the saline implants: gel implants are softer, more natural, more comfortable, and longer lasting.
If your original surgeon is unwilling to do this (why?) seek a few opinions from board certified surgeons in your area.
Implants Look Different, Can It Be Fixed?
Thanks for the photos posted. Yes they can be revised in a surgery, now. Over the internet I see multiple issues with your result. Best to obtain in person opinions from boarded surgeons in your area, like Drs Jack Fisher or Pat Maxwell.
Breast asymmetries following a breast augmentation
There are several issues which have combined to give you the present result. First of all, you were both asymmetical and drooping prior to surgery with the left side lower than the right. These haven't been adequately corrected with surgery which apparently involved a peri-areolar mastopexy. A full (anchor shaped) approach would have provided you with a better shape, improved nipple size and position and greater symmetry.
It also appears that your right breast implant is too high and will not come down short of a lowering of the crease on that side though there may be secondary issues related to this.
Finally, your implant size may be a bit too big for you - both short term and long term.
Postoperative questions after breast lift/augmentation
In this photograph, the right implant is too high and the most likely reason is scar tissue formation around the implant (capsule). Releasing the capsule would improve the appearance. Also, the nipple position is asymmetric and should be corrected at the same time.
Unilateral capsulotomy may improve assymmetry after breast augmentation
Judging from the pictures submitted (and obviously not from a formal consultation and examination), your right implant appears to be significantly higher than the left. A capsulotomy may be performed under local anesthesia in the office, under sterile conditions. This is not a major procedure and has a significant chance of lowering the implant on the right and giving improved symmetry. Your nipples are now higher than prior to surgery; depending on your preferences, further elevation or lift may also be appropriate. Make sure you consider all the risks and benefits to any further procedures prior to surgery. I hope this helps.